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psnet.ahrq.gov/issue/strengths-and-weaknesses-working-global-trigger-tool-method-retrospective-record-review-focus
March 24, 2012 - Study
Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews with team members.
Citation Text:
Schildmeijer K, Nilsson L, Perk J, et al. Strengths and weaknesses of working with the Global Trigger Tool method for r…
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psnet.ahrq.gov/issue/wide-variation-and-overprescription-opioids-after-elective-surgery
April 24, 2018 - Study
Classic
Wide variation and overprescription of opioids after elective surgery.
Citation Text:
Thiels CA, Anderson SS, Ubl DS, et al. Wide Variation and Overprescription of Opioids After Elective Surgery. Ann Surg. 2017;266(4):564-573. doi:10.1097/SLA.00000…
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psnet.ahrq.gov/issue/opioid-prescribing-decreases-after-learning-patients-fatal-overdose
January 18, 2023 - Study
Emerging Classic
Opioid prescribing decreases after learning of a patient's fatal overdose.
Citation Text:
Doctor JN, Nguyen A, Lev R, et al. Opioid prescribing decreases after learning of a patient's fatal overdose. Science. 2018;361(6402):588-590. doi:10…
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psnet.ahrq.gov/issue/are-verbal-orders-threat-patient-safety
July 31, 2008 - Review
Are verbal orders a threat to patient safety?
Citation Text:
Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care. 2009;18(3):165-168. doi:10.1136/qshc.2009.034041.
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psnet.ahrq.gov/issue/medication-errors-care-transition-trauma-patients
September 02, 2020 - Study
Medication errors in the care transition of trauma patients
Citation Text:
Martín Mª ÁP, García MM, Silveira ED, et al. Medication errors in the care transition of trauma patients. Eur J Clin Pharmacol. 2019;75(12):1739-1746. doi:10.1007/s00228-019-02757-3.
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psnet.ahrq.gov/issue/patient-safety-incidents-associated-equipment-critical-care-review-reports-uk-national
November 29, 2023 - Study
Patient safety incidents associated with equipment in critical care: a review of reports to the UK National Patient Safety Agency.
Citation Text:
Thomas AN, Galvin I. Patient safety incidents associated with equipment in critical care: a review of reports to the UK National Patie…
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psnet.ahrq.gov/issue/estimating-breast-cancer-overdiagnosis-after-screening-mammography-among-older-women-united
October 19, 2022 - Study
Estimating breast cancer overdiagnosis after screening mammography among older women in the United States.
Citation Text:
Richman IB, Long JB, Soulos PR, et al. Estimating breast cancer overdiagnosis after screening mammography among older women in the United States. Ann Intern Med…
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psnet.ahrq.gov/issue/diagnostic-delays-among-covid-19-patients-second-concurrent-diagnosis
March 08, 2023 - Study
Diagnostic delays among COVID-19 patients with a second concurrent diagnosis.
Citation Text:
Freund O, Azolai L, Sror N, et al. Diagnostic delays among COVID‐19 patients with a second concurrent diagnosis. J Hosp Med. 2023;18(4):321-328. doi:10.1002/jhm.13063.
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psnet.ahrq.gov/issue/verifying-patient-identity-and-site-surgery-improving-compliance-protocol-audit-and-feedback
October 26, 2010 - Study
Verifying patient identity and site of surgery: improving compliance with protocol by audit and feedback.
Citation Text:
Garnerin P, Arès M, Huchet A, et al. Verifying patient identity and site of surgery: improving compliance with protocol by audit and feedback. Qual Saf Health …
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psnet.ahrq.gov/issue/impact-sample-size-variation-adverse-events-and-preventable-adverse-events-systematic-review
May 15, 2024 - Review
Impact of sample size on variation of adverse events and preventable adverse events: systematic review on epidemiology and contributing factors.
Citation Text:
Lessing C, Schmitz A, Albers B, et al. Impact of sample size on variation of adverse events and preventable adverse eve…
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psnet.ahrq.gov/issue/incidence-adverse-events-among-home-care-patients
December 04, 2015 - Study
The incidence of adverse events among home care patients.
Citation Text:
Sears NA, Baker R, Barnsley J, et al. The incidence of adverse events among home care patients. Int J Qual Health Care. 2013;25(1):16-28. doi:10.1093/intqhc/mzs075.
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psnet.ahrq.gov/issue/embedded-checklist-anesthesia-information-management-system-improves-pre-anaesthetic
June 26, 2019 - Study
An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting.
Citation Text:
Wetmore D, Goldberg A, Gandhi N, et al. An embedded checklist in the Anesthesia Information Manageme…
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psnet.ahrq.gov/issue/frequency-and-risk-factors-medication-errors-pharmacists-during-order-verification-tertiary
January 23, 2013 - Study
Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center.
Citation Text:
Gorbach C, Blanton L, Lukawski BA, et al. Frequency of and risk factors for medication errors by pharmacists during order verification in a…
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psnet.ahrq.gov/issue/review-healthcare-failure-mode-and-effects-analysis-hfmea-radiotherapy
June 13, 2011 - Review
A review of healthcare failure mode and effects analysis (HFMEA) in radiotherapy.
Citation Text:
Giardina M, Cantone MC, Tomarchio E, et al. A Review of Healthcare Failure Mode and Effects Analysis (HFMEA) in Radiotherapy. Health Phys. 2016;111(4):317-26. doi:10.1097/HP.0000000000…
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psnet.ahrq.gov/issue/impact-medication-reconciliation-improving-transitions-care
June 19, 2019 - Review
Emerging Classic
Impact of medication reconciliation for improving transitions of care.
Citation Text:
Redmond P, Grimes TC, McDonnell R, et al. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018;8(8):C…
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psnet.ahrq.gov/issue/frequency-passive-ehr-alerts-icu-another-form-alert-fatigue
January 23, 2017 - Study
Frequency of passive EHR alerts in the ICU: another form of alert fatigue?
Citation Text:
Kizzier-Carnahan V, Artis KA, Mohan V, et al. Frequency of Passive EHR Alerts in the ICU: Another Form of Alert Fatigue? J Patient Saf. 2019;15(3):246-250. doi:10.1097/PTS.0000000000000270.
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psnet.ahrq.gov/issue/clinicians-perceptions-medication-errors-opioids-cancer-and-palliative-care-services-priority
June 01, 2016 - Commentary
Clinicians' perceptions of medication errors with opioids in cancer and palliative care services: a priority setting report.
Citation Text:
Heneka N, Shaw T, Azzi C, et al. Clinicians' perceptions of medication errors with opioids in cancer and palliative care services: a prio…
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psnet.ahrq.gov/issue/immersive-high-fidelity-simulation-critically-ill-patients-study-cognitive-errors-pilot-study
August 15, 2018 - Study
Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study.
Citation Text:
Prakash S, Bihari S, Need P, et al. Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. BMC Med Educ. 2017;17(1…
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psnet.ahrq.gov/issue/patient-safety-incidents-endoscopy-human-factors-analysis-non-procedural-significant-harm
January 29, 2020 - Study
Patient safety incidents in endoscopy: a human factors analysis of non-procedural significant harm incidents from the National Reporting and Learning System (NRLS).
Citation Text:
Ravindran S, Matharoo M, Rutter MD, et al. Patient safety incidents in endoscopy: a human factors anal…
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psnet.ahrq.gov/issue/accident-analysis-large-scale-technological-disasters-applied-anaesthetic-complication
November 16, 2022 - Study
Classic
Accident analysis of large-scale technological disasters applied to an anaesthetic complication.
Citation Text:
Eagle CJ, Davies JM, Reason J. Accident analysis of large-scale technological disasters applied to an anaesthetic complication. Can J An…